Langenbeck's Archives of Surgery

, Volume 403, Issue 5, pp 607–614 | Cite as

Comparison of perioperative and oncological outcome of thoracoscopic esophagectomy in left decubitus position and in prone position for esophageal cancer

  • Shirou Kuwabara
  • Kazuaki Kobayashi
  • Akira Kubota
  • Ikuma Shioi
  • Kenji Yamaguchi
  • Norio Katayanagi



The aim of this study was to clarify the differences between thoracoscopic esophagectomy in the left decubitus position (LP) and in the prone position (PP) in terms of short-term perioperative outcomes and long-term oncological outcomes after more than 5 years of follow-up.


Patients with esophageal cancer who underwent thoracoscopic esophagectomy and were followed up for more than 5 years were analyzed retrospectively. Of 142 patients, 72 underwent LP esophagectomy and 70 underwent PP esophagectomy. Operation time, blood loss, operative morbidity, mortality, length of hospital stay, and the number of dissected lymph nodes were compared to evaluate short-term outcomes. Cancer recurrence and overall survival were compared to examine long-term outcomes.


Patient and tumor characteristics were not different between the LP and PP groups except for the rate of neoadjuvant chemotherapy. Blood loss was significantly lower in the PP group than in the LP group. Incidence of Clavien-Dindo (C.D.) grade ≥ III complications was significantly lower in the PP group than in the LP group. Pulmonary complications were also significantly lower in the PP group than in the LP group. Operation type (LP versus PP) was identified as an independent risk factor for pulmonary complications (odds ratio 0.27, p = 0.03) by multivariate analysis. Cancer recurrence rate, initial recurrence site, and overall survival rate were not different between the two groups.


PP is regarded as a less invasive procedure than LP with the same oncological effect.


Thoracoscopy Esophagectomy Prone position Left decubitus position Outcome 


Authors’ contributions

SK contributed to the study design, analysis, and interpretation of data and writing of the manuscript. KK and IS participated in the acquisition and analysis of data. AK and KY contributed to the analysis and interpretation of data. NK participated in the study conception and critical review.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.


  1. 1.
    Cuschieri A (1994) Thoracoscopic subtotal oesophagectomy. Endosc Surg Allied Technol 2:21–25PubMedGoogle Scholar
  2. 2.
    Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS, Venkatachlam S (2006) Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position—experience of 130 patients. J Am Coll Surg 203:7–16CrossRefPubMedGoogle Scholar
  3. 3.
    Smithers BM, Gotley DC, Martin I, Thomas JM (2007) Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 245:232–240CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Zingg U, McQuinn A, DiValentino D, Esterman AJ, Bessell JR, Thompson SK, Jamieson GG, Watson DI (2009) Minimally invasive versus open esophagectomy for patients with esophageal cancer. Ann Thorac Surg 87:911–919CrossRefPubMedGoogle Scholar
  5. 5.
    Yatabe T, Kitagawa H, Yamashita K, Hanazaki K, Yokoyama M (2013) Comparison of the perioperative outcome of esophagectomy by thoracoscopy in the prone position with that of thoracotomy in the lateral decubitus position. Surg Today 43:386–391CrossRefPubMedGoogle Scholar
  6. 6.
    Sobin LH, Gospodarowicz MK, Wittekind C (2009) International Union Against Cancer. Oesophagus including oesophagogastric junction (2009). In: TNM classification of malignant tumours. Wiley-Blackwell, West Sussex, pp 66–72Google Scholar
  7. 7.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kuwabara S, Ktayanagi N (2010) Comparison of three different operative methods of video-assisted thoracoscopic esophagectomy. Esophagus 7:23–29CrossRefGoogle Scholar
  9. 9.
    Osugi H, Takemura M, Higashino M, Takada N, Lee S, Ueno M, Tanaka Y, Fukuhara K, Hashimoto Y, Fujiwara Y, Kinoshita H (2002) Video-assisted thoracoscopic esophagectomy and radical lymph node dissection for esophageal cancer. A series of 75 cases. Surg Endosc 16:1588–1593CrossRefPubMedGoogle Scholar
  10. 10.
    Teshima J, Miyata G, Kamei T, Nakano T, Abe S, Katsura K, Taniyama Y, Sakurai T, Hikage M, Nakamura T, Takaya K, Zuguchi M, Okamoto H, Youhei O, Ohuchi N (2015) Comparison of short-term outcomes between prone and lateral decubitus positions for thoracoscopic esophagectomy. Surg Endosc 29:2756–2762CrossRefPubMedGoogle Scholar
  11. 11.
    Koyanagi K, Ozawa S, Tachimori Y (2016) Minimally invasive esophagectomy performed with the patient in a prone position: a systematic review. Surg Today 46:275–284CrossRefPubMedGoogle Scholar
  12. 12.
    Tanaka E, Okabe H, Kinjo Y, Tsunoda S, Obama K, Hisamori S, Sakai Y (2015) Advantages of the prone position for minimally invasive esophagectomy in comparison to the left decubitus position: better oxygenation after minimally invasive esophagectomy. Surg Today 45:819–825CrossRefPubMedGoogle Scholar
  13. 13.
    Otsubo D, Nakamura T, Yamamoto M, Kanaji S, Kanemitsu K, Yamashita K, Imanishi T, Oshikiri T, Sumi Y, Suzuki S, Kuroda D, Kakeji Y (2017) Prone position in thoracoscopic esophagectomy improves postoperative oxygenation and reduces pulmonary complications. Surg Endosc 31:1136–1141CrossRefPubMedGoogle Scholar
  14. 14.
    Shen Y, Feng M, Tan L, Wang H, Li J, Xi Y, Wang Q (2014) Thoracoscopic esophagectomy in prone versus decubitus position: ergonomic evaluation from a randomized and controlled study. Ann Thorac Surg 98:1072–1078CrossRefPubMedGoogle Scholar
  15. 15.
    Noshiro H, Iwasaki H, Kobayashi K, Uchiyama A, Miyasaka Y, Masatsugu T, Koike K, Miyazaki K (2010) Lymphadenectomy along the left recurrent laryngeal nerve by a minimally invasive esophagectomy in the prone position for thoracic esophageal cancer. Surg Endosc 24:2965–2973CrossRefPubMedGoogle Scholar
  16. 16.
    Watson A (1994) Operable esophageal cancer: current results from the West. World J Surg 18:361–366CrossRefPubMedGoogle Scholar
  17. 17.
    Noshiro H, Yoda Y, Hiraki M, Kono H, Miyake S, Uchiyama A, Nagai E (2016) Survival outcomes of 220 consecutive patients with three-staged thoracoscopic esophagectomy. Dis Esophagus 29:1090–1099CrossRefPubMedGoogle Scholar
  18. 18.
    Markar SR, Wiggins T, Antonowicz S, Zacharakis E, Hanna GB (2015) Minimally invasive esophagectomy: lateral decubitus vs. prone positioning; systematic review and pooled analysis. Surg Oncol 24:212–219CrossRefPubMedGoogle Scholar
  19. 19.
    Feng M, Shen Y, Wang H, Tan L, Zhang Y, Khan MA, Wang Q (2012) Thoracolaparoscopic esophagectomy: is the prone position a safe alternative to the decubitus position? J Am Coll Surg 214:838–844CrossRefPubMedGoogle Scholar
  20. 20.
    Kaburagi T, Takeuchi H, Kawakubo H, Omori T, Ozawa S, Kitagawa Y (2014) Clinical utility of a novel hybrid position combining the left lateral decubitus and prone positions during thoracoscopic esophagectomy. World J Surg 38:410–418CrossRefPubMedGoogle Scholar
  21. 21.
    Komine S, Tanaka Y, Kawashima Y et al (2014) Short-term postoperative superiority and 5-year follow up outcomes of video-assisted thoracoscopic esophagectomy for treatment of esophageal caricinoma: a historical comparison with conventional open esophagectomy under a single experienced surgeon. Esophagus 11:54–63CrossRefGoogle Scholar
  22. 22.
    Kitagawa H, Namikawa T, Munekage M, Fujisawa K, Munekgae E, Kobayashi M, Hanazaki K (2016) Outcomes of thoracoscopic esophagectomy in prone position with laparoscopic gastric mobilization for esophageal cancer. Langenbeck's Arch Surg 401:699–705CrossRefGoogle Scholar
  23. 23.
    Baba Y, Yoshida N, Shigaki H, Iwatsuki M, Miyamoto Y, Sakamoto Y, Watanabe M, Baba H (2016) Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg 264:305–311CrossRefPubMedGoogle Scholar
  24. 24.
    Saeki H, Tsutsumi S, Tajiri H, Yukaya T, Tsutsumi R, Nishimura S, Nakaji Y, Kudou K, Akiyama S, Kasagi Y, Nakanishi R, Nakashima Y, Sugiyama M, Ohgaki K, Sonoda H, Oki E, Maehara Y (2017) Prognostic significance of postoperative complications after curative resection for patients with esophageal squamous cell carcinoma. Ann Surg 265:527–533CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Shirou Kuwabara
    • 1
  • Kazuaki Kobayashi
    • 1
  • Akira Kubota
    • 1
  • Ikuma Shioi
    • 1
  • Kenji Yamaguchi
    • 1
  • Norio Katayanagi
    • 1
  1. 1.Department of Digestive SurgeryNiigata City General HospitalNiigata CityJapan

Personalised recommendations